Washington is slashing funding to “navigator” programs that enroll people in health insurance under the Affordable Care Act. Some are being closed entirely, just weeks ahead of the enrollment period.

RENEE MONTAGNE, HOST:

With Republican lawmakers unable to repeal and replace the Affordable Care Act, President Trump has taken several steps to undo it. Just before the weekend, he refused to pay the subsidies to insurers that helped keep premiums down for low-income people. And, also, the administration is cutting funding for outreach to those who want to sign up when open enrollment begins next month. The Affordable Care Act provides money to organizations that help people navigate the health care system. In fact, they’re called navigator programs. Last year, they received $63 million from the government. The Trump administration has cut that funding by 41 percent. I’m joined by Lisa Hamler-Fugitt, she’s executive director of the Ohio Association of Food Banks, which oversees a navigator program. Welcome.

LISA HAMLER-FUGITT: Thank you.

MONTAGNE: And your program’s budget was reduced by how much?

HAMLER-FUGITT: Seventy one percent – nearly $1.2 million dollars. And it was a significant reduction.

MONTAGNE: A significant reduction. So what was the money paying for?

HAMLER-FUGITT: We hired 54 navigators that worked in all areas of the state – both urban and rural areas – hard-to-reach communities that were providing unbiased information that allowed individuals to make the appropriate choices about health care for themselves and their families.

MONTAGNE: And the Trump administration has said that some of these many navigator programs were failing to meet their targets, that they were going to put the largest reductions on to the groups that weren’t performing. How does that apply to you?

HAMLER-FUGITT: It does not apply to the Ohio Association of Food Banks and our consortia partners. We have served for four years to carry out navigator activities in the state of Ohio. And for those four years, we have met, nearly met or exceeded all of our deliverables. All of the feedback that we had received was very positive – keep up the great work. We certainly wish other states would perform to your level and standards. I believe at one point they even said that we were, quote, “rock stars.”

MONTAGNE: So I can – may I presume that you were shocked?

HAMLER-FUGITT: Shocked would be an understatement, but really deeply, deeply and profoundly disappointed and felt as though, quite frankly, we were being held hostage in the belief that it was really – appeared to be a political maneuver to damage the viability and stability of the Affordable Care Act. And at that point, our members voted unanimously to terminate our contract on navigator services in Ohio.

MONTAGNE: Well, one thing – the administration has argued that there are fewer people signing up under the exchanges. Is there, in fact, really the same need as there was when the law first went into effect? I mean, are you seeing – have you been seeing fewer people sign up over the years?

HAMLER-FUGITT: No. No. And quite the opposite, in fact. Since inception, and the enrollments continue to go up, we – nearly a million Ohioans have gained access. So what the Trump administration has stated is clearly not the experiences that we had and continue to have in the state of Ohio.

MONTAGNE: That’s Lisa Hamler-Fugitt. She’s executive director of the Ohio Association of Food Banks. Thanks very much for joining us.

HAMLER-FUGITT: Thank you so much.

(SOUNDBITE OF KHALID SONG, “LOCATION (EYESLOW TRAP REMIX)”)

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NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

The Trump administration issued big policy changes to the Affordable Care Act. Kaiser Health News chief Washington correspondent Julie Rovner explains what this could mean to the millions of Americans who signed up for it.

MICHEL MARTIN, HOST:

We’re going to dig in a little deeper on these big policy changes that the Trump administration is trying to make to the Affordable Care Act. And we’re going to talk about what it could mean to the millions of Americans who signed up for health insurance because of it. We’re particularly interested in people who are likely to be hit with steep insurance premium rises. And we’re joined now by Julie Rovner, who’s been covering this for Kaiser Health News. Julie, thanks so much for joining us once again.

JULIE ROVNER: My pleasure.

MARTIN: So, first, could you take a step back and remind us who got health insurance in the first place because of the ACA? Who are the newly insured? And how many people are we talking about?

ROVNER: Well, we’re talking about 20 million people total. Many of them got insured through expanded Medicaid which most of the states have now done, but another several million were able to buy insurance for the first time partly because they had been shut out before because they may have had pre-existing conditions and insurers simply wouldn’t sell them insurance or because they were getting help paying their premiums, which the Affordable Care Act offered. So people who might not have been too sick to get insurance but still couldn’t afford it could now afford it.

MARTIN: And walk us through what happened this past week and who is most likely to be affected.

ROVNER: So the president did two different things. First, he did this executive order which didn’t actually change anything. It just ordered the relevant agencies – and that would be the Department of Health and Human Services and Labor and Treasury – to put out regulations to basically see if they could make less comprehensive, lower cost coverage more available.

Then late Thursday night, the President did something that does happen immediately. He said that he would stop paying these cost sharing subsidies. It’s about $7 billion for lower-income people – people under 250 percent of poverty, about $30,000 for an individual. Those people were getting extra help not just paying their premiums but paying their out-of-pocket costs – these, you know, multi-thousand dollar deductibles and co-payments and co-insurance. Interestingly though, those subsidies aren’t going to stop. They’re required under the law. Insurers are required to provide it to those people. So the question is, what becomes of that money that the insurers are now getting?

MARTIN: Yes, so what does become of that?

ROVNER: So the insurers have a couple of options. One of them is to raise rates, and a lot of them have done that. And a lot of them did that already with the anticipation that the president might stop making these payments. One of them is to leave the market entirely, which we’re now seeing some insurers thinking about doing. And the third one is to just eat the increased costs, which we assume none of the insurance companies are going to do.

But the people who are going to get hit the hardest are the people who don’t get help paying their premiums because they’re going to load this money that they’re not getting anymore onto the premiums. And we’re looking at people who make not a ton of money, 400 percent of poverty is about $64,000 for a couple. Those people may be asked to suddenly pay tens of thousands of dollars more.

MARTIN: Do we have a sense of who these people are?

ROVNER: So who these people are – they tend to be older because they have higher premiums. They may be early retirees who are not yet eligible for Medicare or they are people who are self-employed. And if you look at the demographics, these are more Republicans than Democrats. So basically what’s happening here is that by stopping paying these subsidies, the president isn’t actually hurting these lower-income people because they still have to get it. He’s hurting these higher-income people, many of whom are Republican voters.

MARTIN: What are the next steps here that we should be looking at as we try to evaluate what’s going to happen?

ROVNER: We’ve already seen 18 states and the District of Columbia file suit to require that the payments be continued. The reason the president was able to stop this is that it was a subject of a lawsuit about whether Congress officially appropriated the money or not. That lawsuit was actually on appeal and the lower court finding had been stayed.

So the president could have kept this money coming, but the states are now going to court to try to get them reinstated. We’ll see. If not, open enrollment is in two and a half weeks. And basically what the president has done – I think this was his intent – is to just confuse things so much as to try to depress enrollment so we can come back and say, look, it’s all failing.

MARTIN: That’s Julie Rovner. She’s chief Washington correspondent for Kaiser Health News. Julie, thanks so much for speaking with us.

ROVNER: You’re so welcome.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

President Trump made headway this week in trying to roll back his predecessor’s policies. NPR’s Domenico Montanaro tells us about Trump’s recent decisions against the Iran deal and the Affordable Care Act.

MICHEL MARTIN, HOST:

We’re going to start the program today trying to make sense out of this week’s news from the nation’s capital. President Trump made some significant headway in trying to reverse his predecessor’s initiatives. The focus was on two big issues – the Iran nuclear deal and the Affordable Care Act. We called NPR political editor Domenico Montanaro to explain all this. Domenico, thanks so much for being with us once again.

DOMENICO MONTANARO, BYLINE: You’re welcome, Michel.

MARTIN: So let’s start with the Iran nuclear deal. The president declined to certify Iran as being in compliance. What does that mean?

MONTANARO: Well, I’ll tell you first what it does not mean. It does not mean that the U.S. has ripped up the Iran deal, which is maybe the way President Trump wanted to spin it. Now what the president is doing by de-certifying the deal is signaling he doesn’t like it. He thinks Iran isn’t living up to its end of the bargain, even though international monitors say actually that’s not true, that they are. Practically speaking, Trump’s move though does start a 60-day clock for Republicans in Congress to re-impose sanctions. That would kill the deal, but here’s the rub. Trump didn’t actually ask them to do that, so there’s no indication they will.

MARTIN: So does this mean this was – what? – theater, bluster?

MONTANARO: Well, what this basically boils all down to is Trump wants to look tough on Iran for his base and frankly for himself. I mean, you know, for years, he’s been criticizing this deal. And it’s probably no coincidence though that his top military advisers – some of the people he’s closest to – have been advising against ripping up the deal. So there’s a lot of bark here, not much bite. But the move could have real unintended consequences for the U.S. internationally. The decision is making allies nervous. And if hardliners in Iran believe that – that the U.S. isn’t serious – it could empower them and weaken some of those moderates who have so far convinced the ayatollah to go along with this.

MARTIN: So let’s turn to healthcare – and I want to mention that we are going to dig into this issue further after this conversation – but a number of congressional efforts to repeal and replace the Affordable Care Act have failed in the last few months. The president’s been warning that he would take matters into his own hands through executive actions if they didn’t do what he said. He did that this week. Remind us exactly what the president did.

MONTANARO: All right, so he made two big moves. First, he signed an executive order that would allow groups of small businesses and associations to band together to buy health care. Health care advocates believe that could be a magnet for young and healthy people and would raise premiums for those who need care because it would be pulling them out of the exchanges. That would undermine those exchanges. Second, and more impactfully (ph) even than that, was that Trump said his administration was no longer going to make payments for subsidies that help people buy insurance – helped make them more affordable. And we’re talking about people with families of four who make up to $97,000 a year. So that’s a lot of people.

You know, without them, the Congressional Budget Office estimates that premiums would spike 20 percent next year, even more after that and wind up costing the government some $200 billion over the next decade. Trump looks like he’s trying to make Democrats cry uncle here, but Democrats called what he’s doing spiteful, sabotage. They don’t look ready to cow to Trump. And it sets up a really potentially messy fight in mid-December. That’s when the debt ceiling needs to be raised. The government needs to be funded and Republicans can’t get the votes most likely without Democrats.

MARTIN: So do you see – do you see Congress acting here?

MONTANARO: It’s going to take like-minded leaders from both parties who don’t want to see the subsidies ended and make them law because, right now, they’re dealing with someone in the White House who doesn’t appear to care about the fallout of his decisions.

MARTIN: That’s NPR’s Domenico Montanaro. Domenico, thank you.

MONTANARO: Thank you, Michel.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Health insurance providers have already raised rates in anticipation of reduced government subsidies. NPR’s Michel Martin talks with health policy analyst Robert Laszewski about how the industry might fare.

MICHEL MARTIN, HOST:

We have one more conversation about healthcare. As we just heard, health insurers are trying to figure out what to do without the reimbursement from the government that the Trump administration says will no longer be paid. The question is, will insurers raise their rates or withdraw from the health exchanges created by the Affordable Care Act? For perspective on this, we called Robert Laszewski. He’s a former insurance executive who’s now a health policy consultant. Mr. Laszewski, thanks so much for speaking with us.

ROBERT LASZEWSKI: You’re welcome.

MARTIN: So based on your knowledge of the industry, what are the options that insurers are considering to deal with the lack of these subsidies?

LASZEWSKI: Well, actually, many of them have already raised the rates. They had to have their 2018 rates into the regulators and approved a couple of weeks ago, so most of them have already made some pretty significant rate increases – between 10 and 20 percent – assuming that Trump would cut off the subsidies. A few insurance companies and a few regulators did not do that. They did not allow for it. I think now what’s going to have to happen is these insurance companies today are having some pretty tense conversations with the regulators, saying, if you want us to stay in the market, you’re going to have to let us raise those rates 10 to 20 percent.

MARTIN: Is it possible or likely that some of these companies will just pull out? And can they do that even if they’ve already offered plans for the coming year?

LASZEWSKI: It is still possible for insurance companies to pull out. The contracts they have with the government have an out clause if there’s a major material change. So it’s possible. More likely, I think you’re going to see some regulators make some accommodations and allow for the higher rates to happen pretty quickly. I don’t think we’re going to see many, if any, pull-outs. Now we’ve got dozens of insurance companies involved, so I wouldn’t be shocked to see one do it. But generally speaking. The carriers have known this is coming, they know what kind of environment they’re in, and they’re pretty much pricing for it.

MARTIN: Let’s say for the sake of argument that companies do pull out of the exchange. Is there a tipping point at which the Affordable Care Act no longer effectively exists?

LASZEWSKI: Well, that’s possible if you had substantial carriers pull out in some of the larger markets – with any markets of any consequence with no insurance company. But I think we’re actually entering a strange period here. The insurance companies are figuring out how to make money in the Obamacare insurance exchanges. They just raise the rates. So the carriers – the insurance companies – are backing into a survivable market here. Run the rates up as high as you have to. They can at least break even. It becomes sustainable for the insurance company, but it’s a terrible situation for people who don’t get subsidies and have to pay the full cost.

MARTIN: So finally, before we let you go, are there other options on the table? Could Congress theoretically, anyway, pass some sort of a patch to fund these cost savings reimbursement?

LASZEWSKI: Absolutely. The Congress could pass legislation not only to fix the cost-sharing subsidy problem that Trump created but to fix a lot of other problems. Obamacare has some very serious architectural problems when it comes to the insurance exchanges. It needs an overhaul minimally. So the Congress could fix it, but here’s the problem – Trump would veto it.

So I think we’re stuck in a really bizarre period right now, one where people getting subsidies are going to be OK. Even though we cut the funding to the insurance companies, they’re going to get their subsidies to help pay for it. But 43 percent of those in the individual market didn’t get a subsidy last year because they made too much money, and those people are really getting hurt.

MARTIN: That’s Robert Laszewski. He’s a health policy consultant, a former insurance executive. He was kind enough to speak to us by phone just outside Washington, D.C. Mr. Laszewski, thanks so much for speaking with us.

LASZEWSKI: You’re welcome.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

President Trump has vowed to get rid of the Affordable Care Act. But with Congress failing to do that, Trump took action this week that could hurts the program.

SCOTT SIMON, HOST:

President Trump promised during his campaign to get rid of the Affordable Care Act. Congressional Republicans couldn’t agree how to do it after several attempts. The president and his administration have taken a series of actions that could undermine the insurance markets that were created by the health care law. The latest came late this week. We’re joined now by NPR health policy correspondent Alison Kodjak. Alison, thanks so much for being with us.

ALISON KODJAK, BYLINE: Thanks for having me, Scott.

SIMON: What exactly did the president do this week?

KODJAK: He took two actions. The first was he signed an executive order that he hopes will allow people and businesses to get together and buy health insurances as a group outside the Affordable Care Act marketplaces. And the idea is the group market power can get a lower price. But there’s a little problem with that in that most people say that the only way this is going to work is if those groups peel off only the healthy people and leave sicker, more expensive people to continue to buy insurance on those ACA exchanges. So then costs would go up for those sick people. In his second act, he ended these payments of some key subsidies to insurance companies. And they offer discounts to low-income customers. So while the mechanics are complicated. The end result of this second move – most economists say it would end up costing middle-income consumers who buy insurance on those exchanges a lot more money.

SIMON: And of course, let’s just note, again, that was just this week. What else has the administration done?

KODJAK: Well, they’ve taken a whole bunch of actions really since the beginning of the year. The president, right after he took office – the Department of Health and Human Services removed a whole bunch of information from its website about how the Affordable Care Act worked and how people can sign up. And then a few weeks ago, the same agency, HHS, said it was going to cut the budget to advertise for open enrollment for the exchanges by 90 percent. And then during this coming open enrollment period, they’ve also announced they’re going to close the marketplace for about 12 hours every week on Sundays, which would be a time that a lot of people might want to sign up.

SIMON: And you’re suggesting that taking it offline for 12 hours is meant to prevent a number of people from signing up?

KODJAK: Well, there are people who criticize the administration and say that’s the case. Now, the administration says they need to take the website down on a, you know, routine basis to perform maintenance. There are those who say they could have done at a different time rather than do it on a Sunday when a lot of people are home and might have time.

SIMON: How are all of these changes likely to affect people?

KODJAK: So you know, it’s hard to say exactly. With the actions this week, some people may see their premiums rise, especially if they don’t get subsidies from the government to help pay for their insurance. And with the rollback in outreach, people could find they don’t know where or how to get insurance. I myself have been getting email messages and messages on Twitter from our listeners who are confused about what’s going on. But then there’s this sort of broader issue. And it’s a little harder to pin down. And that’s just – there’s all this talk about the ACA collapsing, about it being repealed. The president says it all the time. The Department of Health and Human Services tweets about it. And that confusion, you know, could make people think they can no longer get insurance or make them think it’s not worth it. So when open enrollment starts, some people just may not sign up.

SIMON: NPR’s Alison Kodjak, thanks so much.

KODJAK: Thank you.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.